Office of Inspector General (OIG) Work Plan
Physician OIG Work Plan for 2009
• Medicare Payments for Colonoscopy Services.
• Medicare Payments for Unlisted Procedure Codes.
• Medicare Billings with Modifier –GY.
Hospital OIG Work Plan for 2009
• Reliability of Hospital-Reported Quality Measure Data.
• Changes Under the MS-DRG System
• Serious Medical Errors (“Never Events”)
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Healthcare Regulatory 2009 Update
Coding and Documentation 2009 Update
2009 Diagnosis Code Changes
2009 CPT Code Changes
2009 HAC & POA Indicator Reporting
Preparing for the RACs
Top 10 RAC/OIG Targets
OIG Work Plan
Employee Benefit Plan Alert: Fiduciaries must focus on Plan Fees
The Potential Liability of Self-Funded Health Insurance Plans
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HealthLine Newsletter Articles
Healthcare Litigation
Health Claims Authorization, Processing and Payment Act
Healthcare Organizations Start to Adopt Sarbanes-Oxley Regulations
The OIG Stresses the Importance of Internal Controls for Hospitals to Reduce Risk
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Presented by
Amper’s Healthcare Services Group
Physician OIG Work Plan for 2009
- Medicare Payments for Colonoscopy Services
- A colonoscopy may include biopsies to remove polyps, tumors, or other lesions
- Consultations/office visits may also be required
- OIG to determine if colonoscopy was properly supported, billed & paid in accordance with Medicare requirements
- Outpatient Physical Therapy Services Provided by Independent Therapists
- Focusing on independent therapists that have a high utilization rate for outpatient therapy services
- Review that services were medically necessary & properly documented
- Medicare Payments for Unlisted Procedure Codes
- Review provider usage of unlisted procedure codes
- Subject to individual review and manual pricing
- Medicare Billings with Modifier –GY
- -GY Modifier
- Services not covered by Medicare
- Medicare beneficiaries are acquiring large medical bills that they are responsible for paying
- OIG examining patterns & trends for physicians & suppliers utilizing modifier -GY
Hospital OIG Work Plan for 2009
- Reliability of Hospital-Reported Quality Measure Data
- Will review hospitals’ controls for ensuring accuracy of data related to quality of care that they submit to CMS for Medicare reimbursement
- Will determine whether hospitals have implemented sufficient controls to ensure their quality measurement data is valid
- Provider Bad Debts
- Will determine whether bad debt payments were appropriate under Medicare regulations
- Will determine if recoveries of prior year writeoffs were properly used to reduce the cost of beneficiary services for the period in which the recoveries were made
- Coding & Documentation Changes Under the MS-DRG System
- Will examine coding trends & patterns under the new system to determine whether certain MS-DRG’s are vulnerable to potential upcoding
- Serious Medical Errors (“Never Events”)
- Will review hospitals’ compliance with CMS requirements by identifying several hospital-acquired conditions using the Present on Admission coding system
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